Universal masking in schools mitigates COVID related inequities, concludes a new study published in the New England Journal of Medicine that not everyone agrees on
Universal masking in schools mitigates COVID related inequities, concludes a new study published in the New England Journal of Medicine that not everyone agrees on
While "Cocooning" around the immunocompromised during the next few months is an excellent idea, according to an audio discussion about the study with NEJM Managing Editor
According to a study by Tori Cowger, Eleanor Murray, Jaylen Clarke, Mary Bassett, Bisola Ojikutu, Sarimer Sánchez, Natalia Linos and Kathryn Hall and published November 9th in the New England Journal of Medicine, removing universal masking policies in Massachusetts schools increased COVID-19 cases by 44.9 for every 1,000 student.
Over 15-week period (March to June 2022) “Covid-19 cases in school districts that had ended universal school masking policies (70 districts for most of the 15-week period) were compared with cases in school districts that sustained universal masking policies (2 districts for most of the 15-week period)” according to the editorial by Julia Raifman, Sc.D. and Tiffany Green, Ph.D also published in NEJM.
Link here for Chart and analysis in New England Journal of Medicine
The Data
The data captured a "staggered policy implementation” as Boston Public Schools gradually removed universal school mask requirements over a course of 15 weeks. The cascade of mask removals enabled researchers to put the staggered timelines under a macro lens. “Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts,” Cowger and colleagues conclude. Infection numbers were consistent throughout the Boston school under universal masking and as masks came off and the data changed, infections went up.
The immunocompromised and “cocooning”
(Cocoon illustration via The Noun Project)
Lindsey R. Baden urges communities to “cocoon” in order to “build a protective sphere” around the vulnerable over the next few months somewhere around the 10 minutes mark of the supplementary audio discussing the study New England Journal of Medicine Deputy Editor.
(I have requested permission to use the audio embedded below and am waiting to hear back. You can also find the downloadable audio on the NEJM here.
It is “very hard to communicate,” Baden explains with exasperation, but masking can and should be deployed as a tool when extra layers of protection are needed.
Boston school study generates a bit of backlash
Cowger and colleagues also discussed disparities due to “chronic underinvestment in combination with structural racism” in their conclusion. “State-sanctioned historical and contemporary policies and practices (e.g., redlining, exclusionary zoning, disinvestment, and gentrification) were called out along with “eroded tax bases in some school districts” and “associated environmental hazards.”
These aspects of the study have drawn criticism in publications ranging from The New York Post (which I don’t care to link to here) to the Sensible Medicine Substack curated by Vinjay Prasad who argues, “Let's not convert a scientific question about whether masks slow viral spread into a referendum about who cares more about structural racism or socioeconomic disparities. Evoking this rhetoric is inappropriate for the New England Journal of Medicine. It is a shame editors allowed it,” before introducing Tracy Beth Hoeg to further support his position as a guest columnist.
As a non-scientist it is difficult to know how to assess the impact “concentrated high-risk conditions, such as crowded classrooms and poor indoor air quality due to outdated or absent ventilation or filtration systems, in low-income and Black, Latinx, and Indigenous communities” had on this particular data set.
I contacted the Centers for the Disease Control and Prevention Media Relations department —something I do more that I like to admit— asking for a response to the NEJM study by Cowger and colleagues and of course I am still waiting to hear back.
Will they respond? I wont hold my breath. Could the research be still used to request ventilation upgrades in low income school districts as well as more robust sick leave policies? It seems a case could be made for using some of these as well as other data points to advocate for better air quality, ventilation and filtration systems.
Speaking of healthy buildings…
…Harvard Chan School of Public Health Associate Professor, Joseph Allen, who also doesn’t respond to my messages, tweeted kudos to the Boston Public School just before the New England Journal of Medicine story ran.
Allen was part of a team that presented at the White House Summit on Indoor Air Quality on October 13th, 2022.
Looking forward to reading “Healthy Buildings” the book Allen coauthored with John Macomber once Audible integrates his 2022 updates into their 2020 edition.